CME Near and Far: Q&A with Frank F. Britt

May 01, 2008

By Pharmaceutical Executive

Pharmaceutical Executive

Continuing medical education (CME) is a complex, shifting sector of the industry. It's hard enough to do great CME domestically, but the difficulties multiply when a company attempts to educate internationally. Frank F. Britt, general manager of Pri-Med's business education unit, has more than 20 years of experience in business and education, and has held senior-level sales, marketing, and operations positions at such companies as IBM, Mainspring, and Accenture. Pharmaceutical Executive talked to Britt about the differences between CME in the United States and abroad.

What are your thoughts on the future of CME on the international stage?

On the one hand, there are significant commonalities in patient issues. On the other hand, there are distinct clinical issues that are unique to the different populations in Europe, Asia, and Latin America. You might think it's obvious that medical education should be the same all over the world, because physicians are physicians and the basic tenets of medicine are mostly the same. The same big pharmaceutical companies tend to be interested in treating particular disease states around the world.

But it's not that simple. On a worldwide basis, there are more differences than similarities. And that's why we're seeing increasing focus on global harmonization. There are panels of people in companies looking at whether or not you can actually harmonize the way CME works. There are differences in regulations and differences in standards. Cultural nuances are very important. Some people see them as quaint local habits, but they're so much more than that. Harmonization is a good aspiration, but there is a decade of work to do before it becomes a reality.

What are some examples of differences in regulations and standards?

In Germany, for example, continuing medical education is mandatory. Doctors have to receive 150 credits over three years. CME is also mandatory in Mexico, France, and the United States. In Spain and Japan it's semi-mandatory, which means that a doctor receives incentives to go to the CME programs, but attendance is not regulated by the government. In Ireland and the United Kingdom, it's voluntary.

One of the things that drives these differences is that there are different national agendas set in each country. For example, in the United Kingdom, about a year ago, the government set up a national service framework around diabetes awareness as a response to the growing national diabetes problem. In Japan, they're specifically trying to develop medical education programs around the issue of stress management. They're trying to respond to the needs of a population that, on average, experiences higher levels of stress than citizens of other nations.

These cultural differences have material, substantive impacts. That's one of the reasons you have to be mass-localized, if you will. The content has to originate locally, or else you'll miss those important considerations that are local to that market.

The infrastructure of CME providers is also vastly different. Here in the United States we have a commercial CME sector, but in other parts of the world there are nonprofit organizations such as medical societies, patient advocacy groups, or even government agencies that actually conduct CME.

Budgets tend to be set up at the local/market level. The funding comes first and foremost from the local country-level managers, and then from the national or global education managers. You're starting to see the emergence of global medical education executives, who are the meta-level educational experts within the big pharmaceutical companies, which complements the local expert.

What are some issues surrounding CME in developing nations?

The core issue has to do with the maturity of the medical infrastructure in the country. Let me give you some perspective on India. Obviously, India's medical education system is one of the largest in the world. They have about 260 medical schools. Those medical schools produce about 30,000 physicians a year.

On the positive side, they're cranking out a lot of physicians to help a population that exceeds a billion people. The bad news is there's an acute shortage of doctors. They still don't have anywhere near the amount of doctors they need to address their populations in the major cities. And the number of physicians is certainly even more insufficient in the secondary markets.

There is also an acute shortage of medical teachers. This problem has been recognized within India. Medical schools have responded by creating incubation centers for post-graduate medical education in India. They've begun holding two-or three-day workshops conducted on a regular basis with the faculty from the medical schools. It's a fledgling effort. There's a recognition of need, but there's nowhere near the maturity of medical education as its own discrete sector as is the case here in the United States. But it's poised to grow as the sophistication of medical practices continues to mature there, the expectations of patients continue to mature, and obviously the number of doctors continues to grow.

What's needed to improve CME here at home?

First, give physicians a voice. When it comes to CME in the United States, there's a lot of people talking about what's right, what's wrong, what works, what doesn't work, who should do what, etc. However, there's very little discussion about the voice of the physician. Physicians need to drive the learning agenda, and they need to have a voice in this very substantive debate about the present and future state of CME.

Second, show up. I can't tell you how many industry conferences I've been to where people have talked about what's going on in CME. But if you actually go to an event and you talk to the physicians in the context of the event, you walk away with a very different perspective. It's one thing to talk about the theory of CME, it's another thing to get texture. Texture doesn't happen by reading. Go see it, feel it, taste it, embrace it.

Third, we all need to raise the bar in terms of innovation. There has to be innovation across all points of the CME experience, whether it's how content is developed and delivered or, ultimately, how the physician experience is manifested.

There are different opinions as to what constitutes innovation in CME. For example, innovation can be represented by different kinds of delivery models, like podcasts. But there also needs to be innovation as it relates to the content. The pay-for-performance movement is going to push us even further toward more collaborative-based education, which is in the interest of patients. We hear a lot of talk about adult learning principles, but real innovation happens in the marketplace and at the event, whether it's live or online.

More doctors are going to CME than ever. I think the marketplace of clinicians speaks volumes about what the truth is—which is that they have an ongoing need and desire for education. They are the ultimate "true north" and the judge of value.